Provider Demographics
NPI:1407889926
Name:OMNI HOME HEALTH CARE, L.L.C
Entity Type:Organization
Organization Name:OMNI HOME HEALTH CARE, L.L.C
Other - Org Name:OMNI HOME HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:KOSHY
Authorized Official - Last Name:ALEX
Authorized Official - Suffix:
Authorized Official - Credentials:BS, RRT
Authorized Official - Phone:972-445-0300
Mailing Address - Street 1:819 NORTH O'CONNOR ROAD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-6125
Mailing Address - Country:US
Mailing Address - Phone:972-445-0300
Mailing Address - Fax:972-445-0301
Practice Address - Street 1:819 NORTH O'CONNOR ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-6125
Practice Address - Country:US
Practice Address - Phone:972-445-0300
Practice Address - Fax:972-445-0301
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009026251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX009026OtherSTATE LICENSE - DADS
TX1662322Medicaid
=========OtherAETNA
TX009026OtherSTATE LICENSE - DADS